| NPI | 1861870933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: TX U0078) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX U0078) |
| 2086S0102X Surgery Surgical Critical Care (Licence: TX U0078) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2025-06-06 |